Employment Application Personal Information: Full Name Phone Number Home Address City State —Please choose an option—ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY ZIP Job Position Applied For Full or Part time Are you available for overtime? NoYes Desired Salary Have you applied to our company previously? NoYes If yes, when? Are you at least 18 years old? NoYes If hired, are you able to submit proof that you are legally eligible for employment in the United States? NoYes Were you referred to work here by anyone? NoYes If yes, by whom? Education: High School or Equivalent: High School Name High School Location Did you receive a degree? NoYes College: Did you attend college? NoYes College Name College Location Did you receive a degree? NoYes If yes, please type the Degree Title References Reference 1: Name Phone Number Address Relationship to you Reference 2: Name Phone Number Address Relationship to you Reference 3: Name Phone Number Address Relationship to you Employment History Most Recent Employer: Employer Name Employer Address May we contact this employer? NoYes Employment Start Date Employment End Date Reason for Leaving Job Title Job Duties Second Most Recent Employer: Employer Name Employer Address May we contact this employer? NoYes Employment Start Date Employment End Date Reason for Leaving Job Title Job Duties Third Most Recent Employer: Employer Name Employer Address May we contact this employer? NoYes Employment Start Date Employment End Date Reason for Leaving Job Title Job Duties Disclaimer and Signature I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Wise Harness Solutions to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment and attendance. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS. Digital Signature (please type your name here) Signing Date